不同起搏模式对病窦综合征患者血浆脑钠肽的影响

Effects of Different Pacing Modes on Plasma Brain Natriuretic Peptide in Sick Sinus Syndrome

[目的]探讨心脏起搏器不同起搏模式对病态窦房结综合征（病窦综合征）患者血浆脑钠肽（BNP）水平的影响.[方法]常规植入起搏器的病窦综合征患者30例,根据不同起搏模式分为心房起搏组[AAI（R）组] 12例和双腔起搏组[DDD（R）组] 18例;分别于术前、术后3个月、术后6个月测定血浆BNP水平.[结果]术后3个月时两组血浆BNP水平均升高,但差异无显著性[（113.8±31.3） pg/mLvs （95.7±53.2） pg/mL,（92.8±87.2） pg/mL vs （70.1 74.6±69.3） pg/mL;均P〉0.05];6个月时AAI（R）组血浆BNP水平与3个月时[（84.8±73.7）pg/mL vs （113.8±31.3 ）pg/mL]比较无升高,而DDD（R）组血浆BNP水平较3个月时进一步升高[（98.8±61.7）pg/mL vs （92.8±87.2 ）pg/mL],但差异仍无统计学意义（P〉0.05）.[结论]病窦综合征患者采用心房起搏AAI（R）和双腔起搏DDD（R）两种工作模式血浆BNP水平虽无明显改变,但长期双腔起搏模式下的右心室心尖部起搏可能有导致血浆BNP水平增高的趋势.

[Objective] To explore the effects of different pacing modes on plasma brain natriuretic peptide （BNP） in patients with sick sinus syndrome （SSS）. [Methods] Thirty patients with SSS undergoing routine pacemaker implantation were enrolled. There were 12 pacemakers with AAI（R） pacing mode [AAI（R） group] and 18 pacemakers with DDD（R） pacing mode [DDD（R） group]. The plasma BNP levels were measured before operation, in 3 months and 6 months after implantation, respectively. [Results]Plasma BNP levels in both groups at 3 months after operation increased [AAI（R） group （113.8 ± 31.3） vs. （95.7±53.2） pg/ mL）] and DDD group （92.8 ± 87.2 vs. 74.6 ± 69.3 pg/mL）, but there was no statistical significance（both P 〉0.05）. The plasma BNP levels in 6 months follow-up had no increment in AAI（R） group comparing with that in 3 months （84.8 ± 73.7 vs. 113.8 ± 31.3 pg/mL）, but a slight increment was observed in DDD group （98.8 ± 61.7 vs. 92.8 ± 87.2 pg/mL）, which had no statistical significance （ P 〉0.05）. [Conclusion]There is no significant difference in plasma BNP level between atrial AAI（R） and dual chamber DDD（R） pacing modes in patients with SSS, but apex of right ventricle pacing with DDD（R） pacing mode may lead to an increment of BNP level.